Day pilots unique residency program, tracks with career theme

Jonathan Day, MD, PharmD, has stayed open to opportunity, which is what made him the perfect first recruit at Iowa for the NIH-funded Stimulating Access to Research in Residency (StARR) program. StARR provides protected, mentored time and funding for a second-year pediatrics or internal medicine resident to spend a year with dramatically reduced clinical responsibilities, allowing them a chance to explore opportunities within research. It is not the typical path for residents, but little about Day’s career path could be called “typical.”

Growing up in a small town in southern Illinois, Day had decided on working in health care, and ended up at the St. Louis College of Pharmacy for graduate studies. After graduation, Day took a job with the United States Public Health Service-Indian Health Service. He accepted an appointment on the Navajo Nation near Shiprock, New Mexico, deferring a medical school admission to serve out his commitment.

From PharmD to MD
For two years, Day worked as a clinical pharmacist alongside providers in internal and family medicine. Additionally, he ran specialty clinics focused on a variety of community health needs from HIV to hepatitis C to blood clots. Day also got a lot of experience treating people diagnosed with cancer. He worked closely with the Health Service physicians and helped manage these patients and educate them on their treatments. He got to know many of the patients well, learning how to navigate a different world and culture, while working with a diverse population. He said he also learned “how to do more with less” in a chronically underfunded health system “with a tight formulary.”

Day’s experience in New Mexico helped remind him of his initial interest in medicine. “I wanted more autonomy in patient care, in the decision-making and being more hands-on.” He said he also found that he enjoyed diagnostic challenges in addition to the therapeutics, with which he was used to working. The health service physicians told him that he thought like them. “I had a lot of patients who told me they wished I was their doctor. When everyone tells you something, perhaps you should listen. Pathways open for you if you’re listening.”

The pathway to Iowa was clear as Day was finishing his MD at Southern Illinois University. The choice of Iowa for internal medicine residency was an easy one for Day. “The people are what make this program and everyone I met just genuinely seemed to care.” Day also pointed out that there was “a strong tradition” of SIU alumni coming to Iowa and even returning after.

The right kind of intern
For most of his academic career, Day said, “research had been a big part of my training.” But with the bulk of residency focused on clinical training, it was not clear to Day how that relationship could continue since he had chosen not to enter the Physician Scientist Training Pathway. Then, on a critical care rotation, Day said David Stoltz, MD, PhD, “found me in the Medical ICU one night last February.”

Stoltz, co-director of the StARR program, asked Day about his path to Iowa, his interests, and what his long-term goals were. Day’s experience working with people with cancer got Stoltz’s attention and he floated the idea of exploring that interest to Day. “Dr. Stoltz told me about this fantastic opportunity and brilliant researchers I could work with to meet my goals. ‘We’ll find things for you,’ he said.”

Stoltz recalled last year’s conversation as well. “Jon just seemed like exactly the kind of curious intern we were looking to recruit for StARR. Every time I talked to him, more ideas popped up. I’m really glad he applied, because he’s shown us that we are exactly the right institution to offer this to residents.”

Diving into opportunities
Day was paired up with Brian Link, MD, professor in Hematology, Oncology, and Blood & Marrow Transplantation. “Dr. Link is an outstanding clinician, mentor, and researcher. I’m very lucky to have the opportunity to work with him.” Day said. “He has been instrumental in making Iowa a leader in lymphoma research.” Day cited Link’s work on the the UI-Mayo SPORE collaboration and the Lymphoma Epidemiology of Outcomes (LEO). “Dr Link is also part of the NCI Lymphoma Steering Committee and the Scientific Advisory Board of the Lymphoma Research Foundation. I have been working with him on some existing projects and collaborations, as well as of getting approval for my own projects.” Day’s interests stretch into the epidemiology of hematologic malignancies and outcomes, including using “real-world data” from academic centers to define patient populations with unmet needs and to answer questions on how the best standards of care can be delivered. Day said he is also interested in “creating useful and data driven tools for clinical use for prognosis, treatment, and outcomes.”

Link said that he was happy to participate as a mentor in the StARR program, seeing the potential and how mentorship shaped his own career. “Like Dr. Day, I came to Iowa for training initially focused on enhancing my clinical skills, but it was the structure of an NIH-funded training grant enhanced by the mentorship and opportunity provided by Dr. George Weiner that opened research opportunities for me. In my case the experience was fundamentally career-altering, and when approached by Drs. Day and Stoltz I recognized an opportunity to pay the system back in some small way.”

Link’s praise for the collaboration goes beyond the program to Day himself. “It turns out Dr. Day is pretty good at this. Our research team is already benefitting from his intellectual curiosity, his literature surveillance skills, his disciplined follow-through, as well as his overall esprit de corps. I hope Dr. Day’s experience in StARR will provide him with the joy of discovering new clinical truths and set him on a path that someday results in him hearing, ‘I wish you were doing research on diseases like mine.’”

Although a year away from traditional PGY-2 clinical duties was not in Day’s original plan, he found himself adapting quickly. “It’s nice to take a step back, sharpen old research skills and acquire new ones,” he said. But he has appreciated the change of pace and setting, as he integrates with the new team. “It has been a good change to allow me to focus on areas of research that I may make a career studying. I can balance lighter clinical responsibilities to allow me to reflect and develop new questions from that clinical time, asking the questions of ‘why is that?’ or ‘what evidence helps us make that decision?’ I have an opportunity this year to take a deep dive in an area that is fascinating to me.”